Community Partnership Fund

Community Partnership Fund

One-year grant report
Grant reports are due December 31 and are required for all grant recipients. If you have questions about your organization’s reporting requirements, please contact CommunityFund@multicare.org.
Select your region*
Organization name*
Contact name*

First NameLast Name
Contact phone number*
Contact email*
example@example.com
Executive director name
Executive director phone number
Executive director email
example@example.com
Project/program name*
Have there been any changes to your organization’s IRS 501(c)(3) nonprofit status since you were awarded this grant? If yes, please explain.*
Describe the progress made toward the stated goals and objectives related to this grant. (500 word maximum)*

0/500
What impact did this grant make in your community or neighborhood and for the population you are serving? (500 word maximum)*

0/500
Were there any unanticipated results, either positive or negative, that you have not already described above? If yes, please describe the implications. (500 word maximum)*

0/500
Describe collaborations, if any, related to the work funded by this grant and how it impacted your efforts.
Will you be continuing this program? If yes, what are the plans for sustaining or expanding the program? For a general operating grant, please answer in terms of the organization. If no, what factors led to this decision?
If you have identified areas where increased collaboration between organizations or sectors would lead to increased positive outcomes for your constituents, please describe your ideas. (500 word maximum)*

0/500
Please share links or screenshots (use the file uploader below) of how your organization has recognized the funding from MultiCare (i.e. social media post, inclusion in newsletter, event sponsorship recognition)*
Upload Screenshots

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Please provide a story or testimonial of someone impacted by the grant funds. You can type out a story or testimonial here or use the file uploader below to provide a Word Document, PDF, etc.*
Upload a story or testimonial.

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Are there other ways to continue our partnership? If yes, how?

Washington State Department of Health Requirements
To meet new Washington State Department of Health requirements, all hospitals in Washington state are now required to report demographic information of our hospital patients and participants in community health improvement programs. While reporting demographic data to the state is mandatory for hospitals, patient and participant responses are voluntary.

Participants in our programs are not required to answer these questions. The intent is that the information collected will be helpful to identifying and addressing health disparities in Washington state and ensuring that participants that need services the most have access.

If your grant funding totaled $5,000 or more, please provide the following information about the participants served by your program.
Participant Demographics

Please select "Add New Entry" for each demographic you are reporting.
Please select "Add New Entry" for each race.
Please select "Add New Entry" for each ethnicity.
Please select "Add New Entry" for each preferred language.
Please select "Add New Entry" for each disability.
Please select "Add New Entry" for each gender identity.
Please select "Add New Entry" for each zip code.
Should be Empty:

Community Partnership Fund

Washington State Department of Health Requirements

Participant Demographics